D.F.C. Azevedo

The ORBITA trial: A point of view

Treatment of stable coronary artery disease (CAD) relies on improved prognosis and relief of symptoms. National and international guidelines on CAD support the indication for revascularization in patients with limiting symptoms and refractory to drug treatment. Previous studies attested the efficacy of angioplasty to improve angina as well as the functional capacity of patients with symptomatic stable CAD. The ORBITA trial, recently published in an international journal, showed no benefit in terms of exercise tolerance compared to a placebo procedure in a population of single-vessel patients undergoing contemporary percutaneous coronary intervention. In this point of view article, the authors discuss the ORBITA trial regarding methodological issues, limitations and clinical applicability.

Myocardial injury in diabetic patients with multivessel coronary artery disease after revascularization interventions

AbstractBackgroundDiabetic patients may be more susceptible to myocardial injury after coronary interventions. Thus, the aim of this study was to assess the release of cardiac biomarkers, CK-MB and troponin, and the findings of new late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) in patients with type 2 diabetes mellitus after elective revascularization procedures for multivessel coronary artery disease (CAD).MethodsPatients with multivessel CAD and preserved systolic ventricular function underwent either elective percutaneous coronary intervention (PCI), off-pump or on-pump bypass surgery (CABG). Troponin and CK-MB were systematically collected at baseline, 6, 12, 24, 36, 48 and 72xa0h after the procedures. CMR with LGE was performed before and after the interventions. Patients were stratified according to diabetes status at study entry. Biomarkers and CMR results were compared between diabetic and nondiabetics patients. Analyses of correlation were also performed among glycemic and glycated hemoglobin (A1c) levels and troponin and CK-MB peak levels. Patients were also stratified into tertiles of fasting glycemia and A1c levels and were compared in terms of periprocedural myocardial infarction (PMI) on CMR.ResultsNinety (44.5%) of the 202 patients had diabetes mellitus at study entry. After interventions, median peak troponin was 2.18 (0.47, 5.14) and 2.24 (0.69, 5.42) ng/mL (Pxa0=xa00.81), and median peak CK-MB was 14.1 (6.8, 31.7) and 14.0 (4.2, 29.8) ng/mL (Pxa0=xa00.43), in diabetic and nondiabetic patients, respectively. The release of troponin and CK-MB over time was statistically similar in both groups and in the three treatments, besides PCI. New LGE on CMR indicated that new myocardial fibrosis was present in 18.9 and 17.3% (Pxa0=xa00.91), and myocardial edema in 15.5 and 22.9% (Pxa0=xa00.39) in diabetic and nondiabetic patients, respectively. The incidence of PMI in the glycemia tertiles was 17.9% versus 19.3% versus 18.7% (Pxa0=xa00.98), and in the A1c tertiles was 19.1% versus 13.3% versus 22.2% (Pxa0=xa00.88).ConclusionsIn this study, diabetes mellitus did not add risk of myocardial injury after revascularization interventions in patients with multivessel coronary artery disease.n Trial Registration Name of Registry: Evaluation of cardiac biomarker elevation after percutaneous coronary intervention or coronary artery bypass graft; URL: http://www.controlled-trials.com.ISRCTN09454308